Nutrition as an important mediator of the impact of background variables on outcome in middle childhood

Patricia Kitsao-Wekulo,Penny Holding,Jane Kvalsvig,H Gerry Taylor,Kevin Connolly,Amina Abubakar

doi:10.3389/fnhum.2013.00713

Abstract

Adequate nutrition is fundamental to the development of a child's full potential. However, the extent to which malnutrition affects developmental and cognitive outcomes in the midst of co-occurring risk factors remains largely understudied. We sought to establish if the effects of nutritional status varied according to diverse background characteristics as well as to compare the relative strength of the effects of poor nutritional status on language skills, motor abilities, and cognitive functioning at school age. This cross-sectional study was conducted among school-age boys and girls resident in Kilifi District in Kenya. We hypothesized that the effects of area of residence, school attendance, household wealth, age and gender on child outcomes are experienced directly and indirectly through child nutritional status. The use of structural equation modeling (SEM) allowed the disaggregation of the total effect of the explanatory variables into direct effects (effects that go directly from one variable to another) and indirect effects. Each of the models tested for the four child outcomes had a good fit. However, the effects on verbal memory apart from being weaker than for the other outcomes, were not mediated through nutritional status. School attendance was the most influential predictor of nutritional status and child outcomes. The estimated models demonstrated the continued importance of child nutritional status at school-age.

Highlights

While the literature provides evidence that the negative effects of early malnutrition persist to school-age (Pollitt et al, 1996), there are several significant knowledge gaps
DISCUSSION the direct effects of poor nutritional status on child neurocognitive functioning have been well-documented in the literature, very little is known about the complexities of that relationship in a multiple risk environment
Through the use of structural equation modeling (SEM), this study has attempted to elucidate some of the pathways through which nutritional status and other contextual characteristics may influence outcome in school-age children

Summary

Introduction

While the literature provides evidence that the negative effects of early malnutrition persist to school-age (Pollitt et al, 1996), there are several significant knowledge gaps. Despite evidence that the impact of nutrition varies across different neurocognitive domains, there have been few studies investigating this area, especially in middle childhood. There is a complex inter-related relationship between poverty, nutritional status and neurocognitive outcomes. Poor nutritional status at this age may have long-term negative consequences and restrict development of a child’s full potential. This is a critical period for investigating the link between malnutrition and developmental outcomes, especially within a multiple risk context. Birth records were used, where available, to confirm the child’s date of birth. Area of residence was characterized as rural or peri-urban according to the most common settlement within the school catchment area

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